Handling confrontation
Anyone working for a company or dealing with the public will occasionally face explosive situations. Managing these situations requires a great deal of skill, not only to defuse the situation, but also to ensure that all the involved parties leave with their feelings, integrity and honour intact. Usually due to stress and fatigue, these sensitive events seem to happen more often towards the end of the year.

Here are four principles that I hope will help you cope:
a) Don’t voice your frustrations to others – rather speak directly to those who have offended you. Confrontation should be done directly and privately and
conducted firmly, but graciously
b) Provide specific facts and stay away from generalisations, in other words use clear examples, without getting emotional. Never confront a person while you
are still angry
c) Inform the other person how you would like them to act – simply identify the problem and calmly suggest ways in which it can be corrected
d) Approach the other person with genuine motives and concern. The aim is to confront, not accuse. Remember that anybody can make mistakes and often people might not even be aware that they have upset you. I hope that these principles will prevent many unnecessary arguments in your pharmacies and enable you to ensure that all your customers leave the pharmacy satisfied and happy.

Regular computer usage has resulted in more and more people visiting the pharmacy to acquire reading glasses. It is also an underlying cause for poor eye health and related health problems. The eye health article on page 6 contains important keys in preventing computer eyestrain.

Feminine hygiene relates to the care of those parts of the female body concerned with reproduction. The reproductive system, like any other part of the anatomy, will function well if the body has adequate nutrition, exercise, rest and elimination. It is important to recognise that concepts of feminine hygiene vary greatly between different cultures. Pharmacy assistants need to be familiar with the different cultural practices, as well as good female health principles – see page 12.

We live and work in a stressful environment and the result of stress on health has been well documented. The article on stress relief in the workplace on page 20 contains important techniques in the management of stress. Other symptoms often seen in the workplace are muscle pain and stiffness (page 24), as well as depression (page 26).

Healthy reading and remember the top achievers, as well as the winner of the Front Shop Pharmacy Assistant of the year, will be published in our December
edition of Front Shop.

Warm wishes

Type 1 Diabetes Mellitus (DM) is also known as Insulin Dependent Diabetes Mellitus (IDDM). As the name suggests patients that are diagnosed with this condition require treatment with insulin (only available in injectable form) for the rest of their lives. Type 1 diabetics depend on insulin for survival. Patients with Type 1 DM do not produce any insulin of their own unlike those with Type 2 DM who usually are managed with oral agents and do have some  insulin production which is inadequate. Patients with Type 2 DM can progress to become insulin dependent.

Diabetes is a life-long disease for which there is not yet a cure. In summary:

• Type 1 diabetes, often called juvenile or insulin-dependent diabetes
• Type 2 diabetes, often called adult or non-insulin-dependent diabetes
• Gestational diabetes, which occurs during pregnancy.

For all types of diabetes, the metabolism of carbohydrates (including sugars such as glucose), proteins, and fats is altered.

PREVALENCE
It is estimated that about 5%–10% of North American diabetes patients have type 1 DM. The prevalence of type 1 in other parts of the world differs. Type 1 diabetes can occur at any age, but it usually starts in people younger than 30.

CAUSES
The cause of Type 1 DM remains largely unknown and is the subject of extensive research. It may affect patients of any age including children and young healthy adults. The thinking is that a trigger factor initiates an autoimmune process in genetically susceptible people. It is thought that the body’s response to a viral infection triggers the autoimmune process. An autoimmune process is a derangement of the immune system whereby the body attacks its own tissue with resultant disease.

In the case of Type 1 DM the target of this process are the Beta (β)-cells in the Islets of Langerhans of the pancreas which are responsible for the production and secretion of insulin. The β-cells are destroyed in the process rendering the individual dependent on exogenous insulin for the rest of their lives.

SYMPTOMS
The role of insulin in the body is to finely regulate glucose metabolism. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life.The lack of insulin results in significantly raised glucose levels in the blood known as hyperglycaemia. This hyperglycaemia spills over into the urine which is usually devoid of glucose in a healthy person-the presence of glucose in urine is known as glycosuria. Hyperglycaemia and glycosuria assist in making the diagnosis of diabetes.

The patient with Type 1 DM typically complains of excessive thirst (polydypsia) and increased frequency of urination (polyuria) which results from the increased blood and urine levels of glucose. Another typical symptom of Type 1 DM is dramatic weight loss as a result of the body’s inability to metabolise ingested glucose.

In summary the presenting symptoms are:

• increased thirst
• increased urination
• weight loss despite increased appetite
• nausea
• vomiting
• abdominal pain
• fatigue
• absence of menstruation

LABORATORY TESTS
The evidence for the diagnosis for Type 1 DM is usually abundant from the history and the symptoms described.

Certain blood tests confirm the diagnosis:

• urinalysis shows glucose and ketone bodies (evidence of the metabolic acidosis known as ketoacidosis  associated with Type 1 DM) in the urine
• fasting blood glucose is elevated
• random (non-fasting) blood glucose exceeds is elevated (this must be confirmed with a fasting test)
• insulin test (low or undetectable level of insulin)
• C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production).This is the most definite laboratory test to distinguish type 1 from type 2 diabetes  as  the C-peptide assay is a measure of endogenous insulin production as external insulin does not have C-peptide in its structure
• Anti-islet antibodies, or lack of insulin resistance, determined by a glucose tolerance test, would also be suggestive of type 1.

TREATMENT   
At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalisation and patients may even present in a hyperglycaemic coma.

The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs, all of these conditions are a results of the long term effects of uncontrolled blood glucose on the vascular and nervous  systems.

These goals are accomplished through education, insulin use, meal planning, weight control, exercise, foot care, and careful self-testing of blood glucose levels.

Insulin
Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with Type I diabetes can’t make their own insulin, and they must take insulin every day.

Insulin is injected under the skin using a syringe, or in some cases, an infusion pump delivers the insulin continuously. It is not available in an oral form because it is a protein which would be degraded by gastric acid before it could be absorbed.

Insulin preparations differ in how fast they start to work and how long they last therefore long acting and short acting insulins are commercially available. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.

Doses are individualised and the injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child’s injections may be given by a parent or other adult. By age 14, most children can be expected to give their own injections.

Diet
Meal planning and the role of the dietician is an essential part of the treatment of diabetes, since food intake and the administration of insulin must be synchronised so as to optimally regulate blood glucose.

Exercise
Regular exercise is especially important for the person with diabetes. Before people with diabetes begin any exercise program, they should obtain medical approval. Type 1 diabetics must take special precautions before, during and after participation in intense physical activity or exercise.

Self-Testing
Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes. Testing will identify high and low blood-sugar levels before serious problems develop.

Foot Care
People with diabetes are prone to foot problems as a complication of the illness. Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to sense trauma or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

Small infections can rapidly progress to gangrene, necessitating amputation of the affected limb.

To prevent injury to the feet, diabetics should adopt a daily foot care routine.

Treating low blood sugar
Low blood sugar, known as hypoglycaemia, can occur in diabetics when they use too much insulin, exercise too much, or have not eaten enough food. Hypoglycaemia can develop quickly. Symptoms include weakness, shaking, sweating, headache, nervousness, and hunger and if left untreated coma. This is a potentially dangerous situation. If these symptoms occur and a blood sugar test kit is available a test should be done.

If the level is low, the person with diabetes should ingest something with sugar such as Coke. If a test kit is not available, sugar should be eaten anyway as there is far more risk associated with hypoglycaemia than hyperglycaemia.

Treating high Ketones
When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous to body tissue. This condition is known as ketoacidosis.

You can check for ketones using a simple urine test available at pharmacies. This test should be performed every 4-6 hours anytime a person with diabetes is registering an abnormally high blood sugar; sick; unusually thirsty or has a dry mouth; urinating frequently; or vomited.

he warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odour.

If these symptoms occur, it is an emergency that can lead to coma and even death.

Follow-Up of the diabetic patient

• Physician/Educator visits at least 4 times a year
• Measurement of  glycosylated haemoglobin (HbA1c) measured 2-4 times a year to evaluate r overall glucose control
• Cholesterol and triglyceride levels and kidney function evaluated yearly
• Yearly consultation with an  ophthalmologist
• Bi-annual dentistry check-ups
• Daily monitoring of feet
• Yearly flu injection unless contra-indicated.

Patient Education
The patient is the most important person in managing their diabetes. Diabetes education is a crucial part of the treatment plan. Diabetes education basically involves learning how to live with diabetes.

The patient should be knowledgeable about the basic principles of diabetes management which include:

• how to recognize and treat low blood sugar (hypoglycaemia)
• how to recognize and treat high blood sugar (hyperglycemias)
• diabetes meal planning
• how to administer insulin
• how to monitor blood glucose and urine ketones
• how to adjust insulin and/or food intake during exercise
• how to handle sick days
• Where to buy diabetic supplies and how to store them.

Prognosis   
The outcome for people with diabetes varies.  To some extent it depends on the attitude of the patient. Recent studies show that tight control of blood glucose can prevent or delay the progression of eye disease, kidney disease and nervous system disease that is caused by diabetes. However, complications may occur even when good diabetes control is achieved with insulin and diet.

Type 1 DM is currently not curable but patients can live a normal and full life provided they abide by the requirements of this condition which need to be integrated into their lifestyles.

It’s nearly Summer time, which means that a lot of people will be heading to the gym or considering some form of exercise in order get fit or lose weight. This could bring them into the pharmacy in order to get some pain relief for the initial muscle pain and stiffness that is likely to occur.

Prevalence
The stiffness resulting from any kind of exercise is not the only reason for muscle pain as there are many other reasons or causes for it. Bearing in mind that the body has 650 muscles, from the tiny facial muscles to the strong muscles in the thighs, and even bending wrong to pick up an object or a child can result in a muscle strain that will be painful for quite a few days.

Muscle aches and pains can involve more than one muscle. Muscle pain also can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs.

Some muscle pain is experienced by all humans at any point in time, some worse than others, and some that will leave a person in short term agony for a few days. Avoiding use of that particularly painful part of the anatomy becomes an art form as the brain does not want the body to experience pain if it can be avoided.

Signs and Symptoms
Pain is normally classified as either acute (of short duration) or chronic (lasts for more than 3 months).
A muscle strain is normally of short duration and the worst pain will improve by day three. Straining the same muscles or muscle group could eventually result in a chronically painful situation that will require some form of medical attention or corrective action.

Physical therapy may be helpful in both situations, once again depending on the severity of the injury.

Prevention
Aching muscles usually recover quite quickly, and below are a few ideas on what to do in event of a muscle injury.

Exercise:
When deciding to follow an exercise regimen, it is essential to warm up before exercising and cooling down afterwards and this includes stretching before and after as well. Take in enough water or fluid to remain well hydrated.

Computer work
When sitting in front of the computer, get up at least once an hour to stretch and relax muscles. Any other kind of office work or where the body remains in the same position should follow the same procedure; get up and stretch to give relief to the muscles that are being used over and over again.

Some cold comfort
The tried and trusted remedy for aching muscles would be to apply ice or a cold compress as it constricts blood vessels and slow the flow of blood which prevents swelling.

Elevating the painful muscle above the level of the heart would help prevent swelling and ease the pain.

Rubbing the muscle is an excellent way of easing the aches and pains. Massaging it personally or going for a massage will relieve the pain, improve the blood flow and help carry away muscle waste products that are causing the pain. In general it is safe to massage muscle injuries, unless it is too painful.

For quite severe pain, doctors recommend compressing the muscle by wrapping it with a bandage or a special compress bandage. This gentle pressure will help prevent swelling and inflammation. Take care not to wrap it too tightly as this can restrict blood flow and could cut off circulation.

Treatment option
There are several products and different treatment options available that will safely treat muscle strain. These can be used in conjunction with the therapies mentioned above if so desired.

Oral versus Topical
There are topical products that can be rubbed into the general area of the muscle pain, or there are oral products that will systemically take care of the pain.

For sore muscles that are the result of overexertion, a topical solution may be the most logical as only the affected area is then treated.

Topical treatments have traditionally been in the form of ointments and salves mixed with healing herbs. Today’s muscle rubs are the more modern form of those recipes and quite a few others have an anti-inflammatory active ingredient that can be absorbed transdermally.

Whereas some rubs have a very strong smell, others have a slight odor that disappears soon after it has been applied and absorption is rapid. The modern gels are absorbed within minutes and do not leave an oily residue on the skin either.

Menthol, clove oil and camphor are often used in topical gels and creams and can be best described as ‘irritating’ ingredients as they cause a mild stinging sensation that some people feel as heat and others as a chill. They work by distracting the nerves and sending a heat/chilling message to the brain, and the nerves can then not carry the sore muscle message at the same time.

Salicylate – this is the active ingredient of aspirin.
If you are avoiding aspirin for any reason, you should avoid topical preparations containing salicylate. Otherwise, it is very effective applied right to the source of the pain, and also serves to reduce inflammation that may be the cause of much of the pain.

There are gels or creams that contain indomethacin (Ado-Indogel or Elmetacin, ibuprofen (Nurofen Gel),  or diclofenac diethylammon (Voltaren Emulgel). In addition there is a patch that contains flurbiprofen (Transact) that can be applied to the skin and removed after 12 hours.

Oral treatment that can be considered could be an analgesic that will ease the pain (a paracetamol such as Panado); anti inflammatory drugs (such as Advil or Nurofen) that will ease the inflammation and have an analgesic and antipyretic effect as well. Aspirin (Disprin) is both analgesic and anti-inflammatory and falls in the same class. Various other combination painkillers are available as well.

If the muscle pain is the result of bruising rather than overexertion, herbal preparations that contain arnica or comfrey can be sondisdered. Arnica stimulates the circulation and speeds the re-absorption of the blood that makes up the bruise.

Referral
As with all health problems that appear small and can be treated at home, always bear in mind that the services of a healthcare practitioner should be considered when:

• A sprain, rather than a strain is suspected and there is immediate swelling and tenderness
• The muscle pain persists beyond 3 days
• There is severe, unexplained pain
• Any sign of infection like redness and swelling is visible around the tender muscle
• There is poor circulation in the area where the pain is
• The muscle pain was not caused by a sprain or strain and the origin is unknown and the pain quite severe.

Conclusion
Muscle sprains and strains are part of everyday life. Most strains are quite treatable and the pain and discomfort is short term. Bending should be done with the knees and not the back to avoid back strain and mild forms of regular exercise can help prevent sudden unexpected injuries caused by a burst of energy that is used indiscriminately at the gym or ‘hitting the road’ with a pair of poor running shoes.

Enjoy a fit and healthy summer!

Arteriosclerosis

The heart pumps blood to nourish all parts of the body, including itself. Blood flows through coronary arteries and into the heart muscle. Coronary artery disease is caused by       arteriosclerosis, which is a gradual build up of material inside the arteries. The blood paths get smaller and decrease the amount of blood that can flow. If a blood clot plugs one of these arteries or blood flow decreases enough, the muscle — starved for oxygen — dies and a heart attack occurs.

Arteriosclerosis is a complex disease, which often progresses slowly for decades and becomes serious only in older age. For some people in their thirties, it develops rapidly. Although men are generally more often at risk at younger ages, young women also develop coronary disease. After menopause, the likelihood of coronary artery disease and heart attacks in women significantly increases. Cholesterol is the most common risk factor but new ground breaking research has shown that there might be much more to worry about!

Homocysteine
High Homocysteine levels are believed to be of much greater concern with regard to heart disease as is the case for many other diseases. Homocysteine is an amino acid (a building block of protein) that is produced in the human body. Scientists have  discovered that Homocysteine may irritate blood vessels, leading to blockages in the arteries. High Homocysteine levels in the blood can also cause cholesterol to change to a form that is more damaging to arteries (called oxidizing low-density lipoprotein). In addition high Homocysteine levels can make blood clot more easily than it should increasing the risk of blood vessel blockages. A blockage might cause a person to have a stroke, heart attack or a problem with blood circulation.

Homocysteine and associated diseases It is becoming general knowledge that most people have elevated levels of Homocysteine putting them at risk of diseases such as, Cardiovascular disease, Arteriosclerosis, Heart attacks, Strokes, Angina, Kidney stones, Alzheimer’s disease and Diabetes related diseases.

Who are at risk?
People with a family history of cardio-vascular disease, diabetes or underactive thyroid glands are at risk for developing high homocysteine levels.  People with high stress levels, smokers, frequent coffee drinkers, people with poor diets and women entering menopause. Certain types of medication can also increase Homocysteine levels, these include medication for elevated cholesterol, diabetes medication, Methothrexate and anti-epileptic medication.

What can you do?
Studies have shown that taking supplements that lower homocysteine levels (i.e. Pro-Vasc) will have beneficial effects.

Diabetes and Alzheimer’s disease.
Diabetes, diabetes associated diseases and Alzheimer’s disease are associated with poor blood circulation. In turn this causes a decrease in the amount of nutrients that reach the cells and a build up of waste products. In the long run it will cause tissue damage. The negative effects of poor blood circulation are well known and range from gradual loss of eye sight and damage of brain tissue to varicose veins.

Free Radicals and the Anti-Oxidant systems.
Free Radical’s are metabolic waste products naturally formed in the body. They cause a number of serious problems and their effects are well documented, problems caused by free radicals range from premature cell aging to arthritis and cancer. Our bodies are however equipped with a strong anti-oxidant mechanism to actively fight free radicals. One of these systems is dependent on the conversion of Homocysteine into N-acetyl L-cysteine a potent neutralizer of free radicals.

Infertility and women’s health.
According to health guru Patrick Halford the single best determinant that a women is ready to conceive is a low Homocysteine level for both the female and male. He further states that provided a person have a level below 6mmol/l they can go ahead and conceive, but with a level above 6mmol/l couples could end up having complications.

Since most women nowadays use oral contraceptives its no wonder that many women have dangerously high Homocysteine level. This is due to the fact that birth control tablets break down the essential nutrients needed to control Homocysteine levels.

Omega-3 fatty acids and mood elevation

A growing number of international research studies show that Omega-3 fatty acids play an important role both in preventing and lifting depression. They also boost the impact of antidepressants in many patients who have not responded well to treatment.

Key omega-3 fatty acids contain eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA). Both are found primarily in oily cold-water fish such as tuna, salmon, and mackerel.

DHA is a major structural component of the brain, the retina of the eye and the phosopholipid membranes around and within the nerve cells. The brain needs Omega-3 fatty acids to function properly and regulate mood because they help to keep its entire traffic pattern of thoughts, reactions and reflexes running smoothly and efficiently.

Omega-3 fatty acids and depression

In a cross-national study published in Lancet, researchers found that when population groups ate high quantities of fatty fishes like salmon and tuna, there was less depression in the areas in which they lived. A later study confirmed that people who ate fish infrequently were significantly more likely to suffer from symptoms of depression than frequent fish eaters.

A similar finding was made with regard to nursing mothers surveyed in 22 countries. In this instance, the study found that when women ate large quantities of seafood and had higher concentrations of DHA in their milk, the occurrence of post-partum depression was lower.

The most impressive clinical trial conducted to date on omega-3 fatty acids was a 12-week, double-blind, placebo-controlled study of 70 participants, all suffering from unipolar depression. The participants had all experienced persistent depression despite taking standard antidepressants at adequate dosages.

In this study, patients received ethyl-EPA and were divided into three dosage groups, taking respectively one, two or four grams daily. The patients receiving one gram per day of EPA responded best, with 53% achieving a 50-percent reduction in their depression scores. They also experienced improvement in their sleep and libido, as well as decreased depression, anxiety, lassitude and suicidal thoughts.

Bipolar mood disorder

People with bipolar mood disorder also respond well to Omega-3 supplementation, but possibly in higher dosages. In the only study conducted to date on bipolar mood disorder, participants received a high dose of 9.6g omega-3 fatty acids per day. Results showed that patients receiving the omega-3 fatty acids remained symptom-free significantly longer than the placebo users and also experienced a significant decrease in depressive symptoms.

Premenstrual syndrome (PMS)

Omega-3 fatty acids can lessen depressive symptoms in women suffering from premenstrual syndrome (PMS). In a three-month trial, 70 women took two grams of krill oil (high in Omega-3) or standard fish oil daily for one month, then for eight days prior to and two days during menstruation for the following two months. Evaluations at 45 and 90 days revealed that participants taking the krill oil experienced significantly less of the depressive symptoms associated with premenstrual syndrome

Major Depressive Disorder affects approximately 121 million people worldwide. The World Health Organization estimates depression will be among the highest-ranking causes of disability in developed countries by 2020, second only to ischemic heart disease worldwide. It can happen to anyone of any age, race or ethnicity; however, women are nearly twice as likely to experience depression as men. Although it is one of the most frequently seen psychiatric disorders in the primary care setting, it often goes undiagnosed or is under-treated. This may be because depressed people often present with physical symptoms rather than emotional complaints; in one large study, 69 percent of patients with MDD reported only physical symptoms as the reason for visiting their physician.

Complete elimination of symptoms, or remission, is the primary goal of depression treatment. Treating the full spectrum of emotional and physical symptoms to remission significantly decreases a patient’s risk of relapse.

Depression, well known to reduce workplace productivity, causes significantly greater productivity declines when accompanied by common co-occurring conditions such as fatigue, sleep problems or anxiety, according to a large new study presented last month at the American Psychiatric Association’s 160th Annual Meeting in San Diego. The study also showed that co-occurring fatigue or sleep problems significantly increased depression-related healthcare costs.

In the study, which used an integrated database of healthcare claims and surveys of almost 14 000 employees at two large U.S. firms, researchers analyzed data on healthcare spending and “presenteeism” (employees’ estimates of their own productivity while at work) to assess the impact of depression and other chronic conditions.

Overall, among the ten most prevalent physical and mental conditions measured, depression had the single largest negative effect on work productivity. That effect was magnified when fatigue, sleep problems and anxiety – conditions that often co-occur with depression – were also present.

Some of the consequences of persistent depression include poor function (work, family and social), poor prognosis (potential for earlier relapse), greater health service utilization and health care costs, and increased morbidity and mortality. The World Health Organisation predicts that by 2020, depression will be the second-largest cause of the global health burden. Other studies, conducted over the last ten years, have further demonstrated the correlation between depression and absenteeism, as well as “presenteeism” (lost productivity while on the job), further reinforcing the high price tag resulting from the condition.

According to a national study, the results of which were published in 1998, the average days lost from work because of illness are: depression – 40 days, heart disease – 37 days, other mental-health disorders – 37 days, lower-back pain – 33 days, hypertension – 28 days and diabetes – 26 days. Furthermore, a study by the Massachusetts Institute of Technology (MIT), found that the costs of depression in the United States is on a par with the costs of heart disease and AIDS, and are higher than strokes, multiple sclerosis and cerebral palsy.

Depression is under treated and often misdiagnosed – because of unreported symptoms by patients, the stigma attached to depression and a lack of knowledge by primary care physicians – who usually serve as the first-line providers for depression.

These studies concluded that the combined burden of costs from lost productivity and low level of treatment for those with depression present cost-effective opportunities for improving depression-related outcomes in the workforce – primarily through appropriate medications, psychotherapy and disease management.

“While depression itself has a significant economic impact, the negative effect on both workplace productivity and healthcare costs can be considerably increased when employees who are depressed also suffer from other conditions,” said Ronald C. Kessler, Ph.D., Professor of Health Care Policy, Harvard Medical School, Boston, Massachusetts. “These findings suggest we should aim to identify and minimize multiple factors associated with depression early to reduce this burden.”

“Companies can help by encouraging employees to go for early screening for depression, providing education within the workplace about depression, implementing employee assistance programmes which are confidential, and encouraging patients to seek treatment,” said Dr Ralph Swindle, a senior research scientist for Lilly in the United States, addressing media on new insights on depression: assessing impact and reaching remission in the real world at the congress last week. “Workplaces should also encourage healthy living and exercise, an excellent adjunct to the treatment and prevention of depression. Employers should also take a look at how the employee’s medical insurance is structured, so as to ensure that cost or access does not heighten the barrier to treatment”.

For more information about depression, speak to your doctor or visit www.depressionhurts.co.za Ends

No matter what ailment a client coming into the pharmacy is suffering from, they will undoubtedly be having issues with stress management.  Since an overwhelming majority of people will say that they experience moderate or even chronic stress daily, pharmacy staff should be ready with a word of practical advice on stress relief.

More than just a luxury, that few people think they can afford, relaxation for stress management is important for both emotional and physical health.  As the body’s stress response is triggered throughout the day one needs to engage in stress detox so as to avoid being in a state of chronic stress. 

Chronic stress is the type that may ruin people’s health and sense of well-being.  Stress related health problems include heart disease, high blood pressure and even the common cold. 

Relaxation
Relaxation techniques help the body to restore itself to its natural state and help a person to become more resilient to stress in the long term.  Stress relief expert and researcher, Dr Elizabeth Scott states that relaxation can occur when a person is just sitting and watching t.v. in a lounge chair (which is what some people think of when they think of the word ‘relaxation’), but having a more structured plan for relaxation can be more helpful in the face of stress

• Breathing Exercises
  These can be the first line of defense against stress. Breathing exercises are wonderful for relaxation because they can be used anytime and at any place, they work quickly, and are easy to master.  Basic and deep breathing as well as deep breathing with visualization are all used as stress relief techniques
• Meditation
  While there are numerous different meditation techniques, a common thread runs through virtually all meditative techniques:
  • Quiet Mind: With meditation, one’s thinking mind becomes quiet. A person stops focusing on the stressors of their day or life’s problems, as well as solving these problems. You just let that voice in your head be quiet, which is easier said than done. This usually takes a bit of practice.
  • Being In The Now: Rather than focusing on the past or the future, virtually all meditative practices involve focusing on right now. This involves experiencing each moment and letting it go, experiencing the next. This, too, takes practice, as most people live most of their lives thinking toward the future or rehashing the past
  Meditation increases brain activity in an area of the brain associated with happiness and positive thoughts and emotions, and some evidence shows that regular practice brings prolonged positive changes in these areas.
• Music
  Playing music is a great way to relive stress and promote relaxation, which could include the whole family.  Because music brings real benefits in terms of wellness (music therapy is a growing field), it can be conveniently used effectively for relaxation as well.
• Exercise
  It may seem that exercise is the opposite of relaxation, but a good workout can actually make a person feel more relaxed afterward for a few reasons: First, working out can be a good way to release stress and blow off steam. Second, the endorphins released during a good workout can aid relaxation quite nicely. Additionally, exercise can get one into a state of flow where it’s difficult to stay stressed—your body has to move toward relaxation as the stress response begins to reverse.
• Having Fun
  Some people may get stressed about getting relaxed! Relaxation methods don’t all have to be clinical and practiced. Letting loose and having fun with family and friends is an excellent way to relieve stress and experience relaxation. The problem is that people don’t always prioritize plain old ‘fun’ as an important part of life—they don’t fit time for it in their busy schedules (at least not nearly as much as they should) because they don’t realize the value of fun for balance as well as physical and emotional health.

Stress release tips
The author, Gaynor McTigue, who wrote the best-selling book “Why Make Yourself Crazy?”, offers this stress-relief strategy:

• Do not multitask
  Multitasking leads to careless mistakes, shoddy work and unreliable performance but, worst of all, having to do things over.
• Be less competitive
  Today, we compete for everything: the space around us, to be first to own a new product, to get our kids signed up for programs, to get our viewpoints across, to be faster, smarter, richer, sexier. Our days are filled with stressful competitions. And most are absolutely unnecessary. Because they’re driven by insecurity, fear of being left behind, an ingrained need to always consume more or better than the next guy. If you want to compete, be the one who stays calm and in control, who isn’t easily sucked in by material things, who avoids being caught up in the daily grab-bag that robs people of their health and peace of mind. 
• Throw something out every dayMost people just have too much stuff! House. Office. Garage. Attic. Useless clutter that’s weighing you down, getting in the way, obscuring the things you really need. Be realistic. If you’re not going to use it, lose it. And you don’t have to make a humongous project out of it. Every day, find one thing you don’t need and toss it. Or give it away. Over time, the clutter will begin to vanish and space and order will magically appear in your home and your life. 
• Eliminate meaningless deadlines
  Our life is full of them. Arbitrary and unrealistic time constraints imposed by ourselves and others that serve only to make us more pressured, anxious, stressed out and for no worthwhile reason. Avoid the trap of assigning time frames to everything you do, especially if you have little idea how long it will take. Instead, make your goal one of completing a project in a careful, professional, satisfying manner. In other words, as long as it takes to do, do right.  Save your nerves, and your energy, for the few real deadlines that you face. 
• Get more out of life by doing less
  Is your life fulfilling, or is it merely crammed? Know the difference and you’ll realize it’s not the quantity of activities you engage in (or possessions you collect) that ultimately determine your happiness. One naturally unfolding, enriching experience can easily surpass many rushed and distracted ones. But you may be so chronically over-scheduled, that you never give yourself a chance to enjoy anything to the fullest.  

Conclusion
Some practical advice for clients suffering from stress, and for pharmacy staff to implement in their lives includes daily relaxation and long-term, directive planning to slowly remove unnecessary stressors from one’s life.  Today’s simplest advice for clients? Have more fun!